<div class="page">
  <header class="bar bar-nav shop-header">
    <a data-dismiss="push" class="icon icon-left pull-left"></a>
    <h1 class="title">运动病史</h1>
  </header>

  <div class="content">
    <div class="content-block">
      
      <form>
        <div style="padding: .5rem .5rem 1rem; margin-bottom: .75rem; width: 100%; background: #ffffff; font-size:.8rem;">
          <p style="font-size: .65rem;">请勾选运动病史:</p>
          <div class="row">
            <label class="col-33">高血压&nbsp;&nbsp;<input type="checkbox" name="history" value="高血压"></label>
            <label class="col-33">低血压&nbsp;&nbsp;<input type="checkbox" name="history" value="低血压"></label>
            <label class="col-33">痛风&nbsp;&nbsp;<input type="checkbox" name="history" value="痛风"></label>
            <label class="col-33">心脏病&nbsp;&nbsp;<input type="checkbox" name="history" value="心脏病"></label>
            <label class="col-33">脊椎病&nbsp;&nbsp;<input type="checkbox" name="history" value="脊椎病"></label>
          </div>
        </div>
        <button id="submit" class="button button-fill button-success button-big button-block" style="background: #FEDC32; color: #000;">确定</button>
      </form>
    </div>
  </div>
</div>